Basic Information
| Provider Information | |||||||||
| NPI: | 1932852985 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | AVENUE 360 HEALTH & WELLNESS PHARMACY - MIDTOWN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2150 W 18TH ST STE 300 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770081289 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8323841423 | ||||||||
| FaxNumber: | 2819741458 | ||||||||
| Practice Location | |||||||||
| Address1: | 2920 FANNIN | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7133413790 | ||||||||
| FaxNumber: | 3462122979 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2022 | ||||||||
| LastUpdateDate: | 01/31/2022 | ||||||||
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| AuthorizedOfficialLastName: | PEER | ||||||||
| AuthorizedOfficialFirstName: | APRIL | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | EVP - FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 7138437359 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HOUSTON AREA COMMUNITY SERVICES, INC. | ||||||||
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| NPICertificationDate: | 01/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0002X | Y | Suppliers | Pharmacy | Clinic Pharmacy |
No ID Information.